
Pain, nausea, uncomfortable skin reactions, hair loss, partial or full breast removal, spread of cancer cells, death—all conditions from which you’d rather prevent yourself or a loved one, right? Imagine if medical professionals recommended a diagnostic test that could allow such outcomes to be prevented, and then—seven years later—said to wait another decade instead.
In November, women ages 40 and younger encountered the exact scenario, which refers to the consequences and preventive testing of breast cancer, a disease expected to appear in around 192,370 new cases and 40,170 deaths among women by 2009’s end, according to the American Cancer Society’s Facts and Figures publication.
In 2002, the U. S. Dept. of Health and Human Services’ Agency for Healthcare Research and Quality‘s Web site released guidelines from the U. S. Preventative Services Task Force (USPSTF) suggesting that all women above age 40 receive annual to biennial mammography screening, which the National Cancer Institute’s Web site describes as a low-dose x-ray procedure that provides an image of breast tissue and that can detect cancerous growths that are too small or too early in development to be distinguished by physical examination. Eager to take the preventative measure, given the disease’s severity, many women complied.

An update to the recommendation, however, was published in the Annals of Internal Medicine in November 2009, revealing the USPSTF’s advising only women ages 50 to 74—and others with particular risks, such as family history of breast cancer—to undergo mammograms, and to do so biennially. The new suggestions sparked a controversy on individual and political planes as women were revealed the conflict between which holds greater risk: prolonging the possible early detection of breast cancer or exposing themselves to potentially harmful radiation and increased chances of overdiagnosis and unnecessary treatment.
Upon hearing the news, for example, 48-year-old Christina Paone found herself torn; while a friend of hers detected the disease at 43 via mammography—which would not have happened had she followed the new suggestions—Christina had also seen her father fall victim to radiation exposure, developing pulmonary fibrosis triggered by radiation from lung cancer treatment.
The study through which the USPSTF supports their suggestions observed negative effects of mammograms which, often misunderstood by the public, did not focus on radiation. According to the study, also published in the Annals of Internal Medicine, researchers looked at false-positive mammograms, unnecessary biopsies, and overdiagnosis, finding that such nonessential treatment often occurred more frequently among women ages 40 to 49.
Despite the paranoia that erupted, professional and political opinions were skeptical; the American Cancer Society’s Web site reveals a statement by Otis W. Brawley, M.D., their chief medical officer, in which he advises women to abide by the previous recommendations. Likewise, on December 2, the Senate voted not only to withhold the older regulations, but also to require health insurance plans to cover mammograms for women age 40 and older, reveals an article on the Associated Press’ Web site.
While women may take comfort in the Senate’s decision, the controversy over the recommendations highlights other issues, particularly pertaining to communication between doctors, patients, and media. Ned Calonge, physician and chairman of the USPSTF, explains in an American Academy of Family Physicians article that the new guidelines were misinterpreted and admits that such was due to the USPSTF’s failure to clarify that they advised only against routine mammograms for 40- to 49-year-old women.
Also concerned with communication barriers, Diane Berardi worries that as she continues to approach the ages around which mammography is concerned, her autonomy as a patient could be compromised. Explaining that while today, she could choose to receive a mammogram covered by her insurance but that future amendments could prevent such, she says, “Someone who I don’t know and who doesn’t know me could be making that choice and determining my future.”

Normal breast tissue cells (left) and cancerous cells (right)
On November 30, UC philosophy professor Dr. Florka held a discussion themed “Addicted to Mammograms,” during which students looked at articles that highlighted how mammography risks were actually nothing new but remain ignored advice and how the recent controversy relates to other preventative medicine risks, like those of cervical cancer. Dr. Florka pointed out the significance of analyzing how the false-positive diagnosis risk compares with the number of breast cancer cases mammography actually prevents, which one of the articles—from The New York Times—explains to be an indicator of far too much screening.
Due to the campus’ large number of students pursuing medical and legal careers, perhaps their concern with the issue isn’t surprising, and considering the enormity of current health reform deliberation, it is certainly not unwarranted.